Patients with Stable Coronary Artery Disease Receiving Chronic Statin Treatment Who Are Undergoing Noncardiac Emergency Surgery Benefit from Acute Atorvastatin Reload

OBJECTIVE: This study was designed to investigate whether patients with stable coronary artery disease (CAD) receiving chronic statin treatment who are undergoing noncardiac emergency surgery benefit from acute atorvastatin reload. METHODS: A total of 500 patients with stable CAD and regular administration of statin before noncardiac emergency surgery were randomized to atorvastatin reload (n = 250) or placebo (n = 250). All patients received atorvastatin treatment thereafter. The primary end point was a 30-day incidence of major adverse cardiac events (MACE). Secondary end points were the incidence of atrial fibrillation (AF) during hospitalization and length of hospital stay. RESULTS: The primary end point occurred in 2.4% of patients treated with atorvastatin reload and in 8% in the placebo arm (p = 0.0088). The incidence of AF during hospitalization was 6.8% in patients treated with atorvastatin reload and 17% in the placebo arm (p = 0.0003). Compared with the placebo arm, the atorvastatin reload arm shortened the length of stay (9.8 ± 3.3 vs. 10.6 ± 3.5 days, p = 0.009). Multivariable analysis suggested that atorvastatin reload conferred a 65% risk reduction of 30-day MACE (odds ratio 0.35, 95% confidence interval 0.18-0.86; p = 0.005). CONCLUSION: The trial suggests that atorvastatin reload may improve the clinical outcome of patients with stable CAD receiving chronic statin treatment who are undergoing noncardiac emergency surgery.